Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis

OBJECTIVE

The purpose of this study was to describe the sequence of psychosocial events and infections preceding the onset of chronic fatigue syndrome (CFS). This information was related to the temporal development of crucial symptoms in relation to the onset of, namely, fatigue, sadness, irritability, pain, and feeling of fever.

METHODS

A personal interview was conducted in 46 patients (mean age, 39.5 years; SD, 9 years) who fulfilled international CFS criteria. These patients were matched with regard to age and gender to 46 carefully matched control subjects. Twenty-three percent of the study subjects were men, and 77% were women. The patient at first identified the month that coincided with the onset of CFS. Similarly, each control subject was asked to identify a "very difficult period" within approximately the same period as the patient with whom the control subject was matched. A list of 14 different life events was perused. Participants were asked to identify for each month whether each of the listed events had occurred. Furthermore, they were asked to rate the importance of the events they had experienced. In addition, for each of the cardinal symptoms (fatigue, sadness, irritability, pain, and feeling of fever) and for each month, the subjects were asked to rate, on a visual analogue scale, the symptom intensity. Also, the number of infections was noted.

RESULTS

A statistically significant group difference in fatigue intensity existed during the period 4 to 10 months before the onset of CFS. During the 3 months preceding the diagnosis for the CFS patients or the peak of the crisis for the control group, there was a dramatic rise in fatigue in both groups. The CFS group reached a much higher fatigue level, which leveled off somewhat during the first year of follow-up but still remained very high in comparison with the control group, which reached precrisis levels 4 months after the peak. Similar patterns were observed for fever and pain. With regard to sadness and irritability, no group difference was observed during the period preceding the crisis. In the patient group, the level stayed high throughout the whole first year of follow-up, whereas a slow return started in the control group; precrisis levels were reached after 1 year in this group. The prevalence ratio (CFS patients/control subjects) for negative events was around 1.0 for the periods 4 to 12 months preceding CFS but 1.9 during the quarter year preceding the onset. For infections, the prevalence ratio increased successively during the four quarters preceding CFS (from 1.4 to 2.3).

CONCLUSIONS

According to the retrospective self-reports, there were differences between the groups in fatigue, pain, and feeling of fever during the months preceding the crisis. With regard to depressive and irritable feelings, no preillness differences were reported between the groups. There was a reported excess prevalence of both infections and negative life events during the quarter year preceding the onset of CFS or crisis. Potential sources of error are discussed. These findings must be replicated in longitudinal studies.

Shiftwork and myocardial infarction: a case-control study

OBJECTIVES

Previous studies have indicated an association between shiftwork and coronary heart disease. The increased risk could be due to job strain, which could act as a mediator of disease. There is also a possibility that interaction between shiftwork and job strain could occur that may induce or modify the development of disease. We conducted this study to explore the relation between shiftwork, job strain, and myocardial infarction.

METHODS

2006 cases with acute first time myocardial infarction were compared with 2642 controls without symptoms of myocardial infarction, and obtained from the same population that gave rise to the cases (population based case-control study).

RESULTS

Myocardial infarction risk was associated with shiftwork both in men (odds ratio (OR) 1.3, 95% confidence interval (95% CI) 1.1 to 1.6) and women (OR 1.3, 95% CI 0.9 to 1.8). In the age group 45-55, the relative risk was 1.6 in men and 3.0 in women. The results cannot be explained by job strain, age, job education level, or smoking. No interaction was found between shiftwork and job strain.

CONCLUSIONS

The findings indicate that shiftwork is associated with myocardial infarction in both men and women. The mechanism is unclear, but the relation cannot be explained by job strain, smoking, or job education level.

Psychophysiological correlates of organizational change and threat of unemployment among police inspectors

The study examined psychosocial work-conditions and physiological reactions among thirty-six police inspectors (median age 45 years, 81% males) who participated in a reorganization. At this time, subjects were threatened by unemployment and had to re-apply for their positions in a new police district. Data were collected during the reorganization and at three years follow-up, by means of questionnaires (Stress Profile) and blood samples. The blood samples were used to determine serum levels of gamma-glutamyltransferase (GGT), glucose, lipids, prolactin, testosterone and cortisol. The results show a positive association between worry about employment and symptoms of burnout during the reorganization. Mean scores for the Stress Profile sub-scales worry about employment (p<.01) and work-load (p<.05) decreased between measurements, but an impairment in relationships with management was noticed (p<.05). No significant changes were observed in terms of self-rated health complaints. Significant decreases in total cholesterol (p<.0001), LDL-cholesterol (p<.0001), LDL/HDL-ratio (p<.01), prolactin (p<.0001), as well as increases in testosterone (p<.01) and cortisol (p<.001) were observed for the whole sample. Glucose decreased with marginal significance (<.07). Controlling for age and gender, multivariate regression analyses showed that subjects who reported deteriorations in satisfaction with work manifested the most modest decreases in prolactin (p<.05). Also, the decrease in glucose was larger for subjects who experienced impairments in satisfaction with work (p<.05), information (p<.05), task-oriented leadership, (p<.05), and respect and dignity (p<.05). Subjects who perceived deteriorations in the ethical and moral standards of the organization increased their cortisol level to a lower degree than their counterparts (p<.05). Favorable changes in employment status and psychosocial work environment seem to be related to improved physiological functioning.

Job strain and biological coronary risk factors: A cross-sectional study of male and female workers in a japanese rural district

To investigate the association between job strain and biological coronary risk factors, a demand-control questionnaire was applied to 138 male (mean age 51.5) and 166 female (50.8) workers in Japanese rural town. In Model I, workers rated as both above the median on demands and below the median on control were defined as a strain group and compared to the rest. In Model II, the effect of a multiplicative term of demands by control was tested once the component main effects were controlled. In both models, possible confounders were controlled. Men in the strain group had higher blood glucose than did the others (Model 1), and the multiplicative term was significantly associated with diastolic blood pressure in men and with Lipoprotein(a) in women (Model II). The results suggest that the demand-control model predicts coronary risk factors in Japanese rural workers, and the associations are different between genders.

High effort, low reward, and cardiovascular risk factors in employed Swedish men and women: baseline results from the WOLF Study

STUDY OBJECTIVE

To examine associations between measures of work stress (that is, the combination of high effort and low reward) and cardiovascular risk factors.

DESIGN

Cross sectional first screening of a prospective cohort study.

SETTING AND PARTICIPANTS

The study was conducted among 5720 healthy employed men and women living in the greater Stockholm area aged 19-70 years. All analyses were restricted to subjects with complete data (n = 4958). The investigation of associations between indicators of effort-reward imbalance and cardiovascular risk factors was restricted to the age group 30-55 years (n = 3427).

MAIN RESULTS

Subjects reporting high effort and low reward at work had a higher prevalence of well known risk factors for coronary heart disease. After adjustment for relevant confounders, associations between a measure of extrinsic effort and reward (the effort-reward ratio) and hypertension (multivariate prevalence odds ratio (POR) 1.62-1.68), increased total cholesterol (upper tertile 220 mg/dl)(POR = 1.24) and the total cholesterol/high density lipoprotein(HDL)-cholesterol ratio (upper tertile 4.61)(POR 1.26-1.30) were found among men. Among women a measure of high intrinsic effort (immersion) was related to increased low density lipoprotein (LDL)-cholesterol (upper tertile 130 mg/dl)(POR 1.37-1.39). Analyses of variance showed increasing mean values of LDL cholesterol with an increasing degree of the effort-reward ratio among men and increased LDL-cholesterol among women with high levels of intrinsic effort (upper tertile of immersion).

CONCLUSIONS

Findings lend support to the hypothesis that effort-reward imbalance represents a specific constellation of stressful experience at work related to cardiovascular risk. The relation was not explained by relevant confounders (for example, lack of physical exercise, body weight, cigarette smoking).

What prevents professional drivers from following physicians' cardiologic advice?

BACKGROUND

There is a scarcity of published studies of the effects of cardiac counselling among professional drivers (PD). Aims of the study were: (1) to examine explanatory variables for two classical 'driver' risk factors - body mass index (BMI), and smoking - and to analyse the interrelations among smoking cessation, losing weight and work-related life changes; (2) to assess the effectiveness of risk factor counselling after 6 months, and (3) to gain insight into possible discrepancies between PD perception of needed changes and compliance with the physician's advice.

METHODS

There were 4 groups of male PD: 13 with ischemic heart disease, 12 hypertensives, 10 borderline hypertensives and 34 normotensives. Baseline cardiovascular risk factors as well as occupational and behavioral data were assessed via questionnaire. The counselling was aimed at smoking cessation, weight loss and promoting leisure-time physical activity. Qualitative methods were used to assess PD perceptions about the work environment and health promotion.

RESULTS

Baseline smoking intensity was best predicted by the total burden of occupational stress and number of smoking years. Baseline BMI was best predicted by long work hours behind the wheel, low availability of attachment outside work and low self-reported job strain. Self-initiated smoking cessation was best predicted by few smoking years, low coffee intake and admitting fear during driving. Physical activity was significantly increased after 6 months. Losing weight was associated with: quitting or diminishing smoking and making other, work-related, life changes. None of the heavy smokers decreased their daily number of cigarettes after 6 months, although expressing the need to do so in self-generated statements.

CONCLUSIONS

Exposure to occupational stressors, mainly, long work hours and the concomitant denial of job strain, in combination with low availability of social attachment outside work, could contribute to maintenance of maladaptive behavior in PD. These findings could serve as a basis for designing standardized intervention trials and suggest that modification of the work environment, with participation of the drivers, is a needed component of such trials. Particular attention should be paid to the length and scheduling of work shifts.

Interview reliability for assessing mental work demands

This study presented and evaluated an interview method for the analysis of tasks included in a work situation. What mental demands and possibilities do the work tasks give rise to? When was the work more or less automatic? When was use of active knowledge required? When were problem solving and planning needed? The study included an assessment of the interobserver reliability of the interviews with employees from 5 different careers: bus drivers (n = 10), home service workers (n = 32), carpenters (n = 11), farmers (n = 14), and teachers (n = 26). The extent to which this method can be reproduced in studies of different occupations is discussed. The interobserver reliability was good (.75-.82). There is support for the stability and usefulness of the interview for most types of work concerning the 3 categories of mental demands: routine, active knowledge, and problem solving/creativity.

Occupational profile and cardiac risk: possible mechanisms and implications for professional drivers

There has been at least forty empirical investigations concerning cardiovascular disease (CVD) among professional drivers (PDs). Standard cardiac risk factor status does not consistently distinguish PDs from other lower risk groups. PDs showed more than twice the overall exposure to stressful work factors compared to referents. They also showed lower maximum bicycle exercise level with a higher double product and higher diastolic blood pressure at the end of exercise compared to controls. Catecholamine excretion has been reported to be elevated during driving. Ambulatory measurements showed higher systolic and diastolic blood pressure in drivers before, during and after driving shifts. Using spectral analysis, the low to high frequency ratio was more than doubled towards the end of a 4-hour drive compared to the early one and a linear increase in 0.1 heart rate variability as a function of distance driven. Reactivity to headlight glare has been shown to roughly parallel the degree of CVD severity in PDs with IHD, essential and borderline hypertension. It was postulated that PDs with IHD form a powerful association between the exposure to glare and the stressfulness of driving and this association was resistant to extinction. The occupational medicine specialist "should have the authority to check the patient regularly in the workplace itself (to ascertain whether or not) the decision to return to work is still valid". An integrated diagnostic approach for PDs might entail using exercise stress testing, with evaluation of silent myocardial ischaemia and heart rate variability during work as well as laboratory tests which simulate aspects of their work environment, with catecholamines measured in relation to these procedures. Assessment of left ventricular mass and further evaluation of atherogenic biochemical abnormalities would be of value for further untangling the mechanisms of cardiac risk among PDs.

Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? Results from Stockholm Heart Epidemiology Program (SHEEP)

The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45-64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8-30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25-50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.

Comparison of stress, job satisfaction, perception of control, and health among district nurses in Stockholm and prewar Zagreb

The increasing number of studies of stress among nurses in the last two decades have mainly dealt with nurses in hospitals. A few studies have included community-based nurses. However, no comparative studies of district nurses in different countries have been published. We have conducted a study to identify sources of stress, job satisfaction, perceived demands, control and health among district nurses (DNs) in Zagreb (Croatia) and Stockholm (Sweden), working in a polyvalent health care organization. Data were obtained regarding altogether 305 district nurses by means of self-administered questionnaires using identical methods and items, with response rates between 88% and 95%. In general, district nurses reported high levels of job-related stress, satisfaction and control. Organizational sources of stress, such as ongoing changes in the primary care organization, and reorganization of tasks, were of importance for the district nurses in Stockholm. They reported also more job satisfaction and commitment than the district nurses in Zagreb. The district nurses in Zagreb had significantly higher level of "lack of resources". They displayed significantly higher scores of psychological demands but also a greater feeling of control than the district nurses in Stockholm. Significant differences were also found between the groups in ranking of self-reported stressors. Thus results show that differences in work organization and in essential resources have a substantial impact of perceived stress, job satisfaction, and on the generality both of single association and on the applications of models.

Gastrin, cholecystokinin, and somatostatin in a laboratory experiment of patients with functional dyspepsia

OBJECTIVE

To explore the pattern of gastrointestinal hormonal variations in plasma and to relate this to possible pathophysiological mechanisms in functional dyspepsia.

METHOD

There were 25 patients, 12 men and 13 women, aged 24 to 50 years, with recurrent functional dyspepsia, compared with community control subjects pair-wise, matched for age and sex. The subjects participated in a laboratory stress experiment with timed provocations. At fixed intervals, 22 samples of blood were drawn from each subject and frozen for later peptide analyses. Levels of gastrin, cholecystokinin (CCK), and somatostatin were measured by radioimmunoassay. Peptide levels were studied during a friendly greeting, a stress interview, and a food stimulation.

RESULTS

Mean hormone values did not differ between the groups. Smokers had lower mean CCK than nonsmokers. Patients with a high degree of dyspeptic symptoms during the week preceding the experiment had a higher mean somatostatin level than patients with a low degree of dyspeptic symptoms. Heartburn correlated positively with the mean somatostatin level. Mean gastrin correlated with body mass index. During the 15-minute stress interview, significant changes in peptide variations were noted: Gastrin increased in both patient and control group subjects. CCK levels increased in patients from 7.2 pmol/l (6.0-8.5) to 9.8 pmol/l (8.2-11.4), but not in control subjects (p < 0.04, two-way interaction). Somatostatin increased significantly earlier in patients than in the control subjects during the stress interview.

CONCLUSIONS

A positive relationship was found between the mean level of somatostatin and the degree of dyspeptic symptoms. Gastrin, CCK, and somatostatin were all sensitive to an anxiety-provoking interview. CCK and somatostatin may possibly link psychological reactions to the pathophysiology of functional dyspepsia.

Current issues relating to psychosocial job strain and cardiovascular disease research

The authors comment on recent reviews of cardiovascular job strain research by P. L. Schnall and P. A. Landsbergis (1994), and by T. S. Kristensen (1995), which conclude that job strain as defined by the demand-control model (the combination of contributions of low job decision latitudes and high psychological job demands) is confirmed as a risk factor for cardiovascular mortality in a large majority of studies. Lack of social support at work appears to further increase risk. Several still-unresolved research questions are examined in light of recent studies: (a) methodological issues related to use of occupational aggregate estimations and occupational career aggregate assessments, use of standard scales for job analysis and recall bias issues in self-reporting; (b) confounding factors and differential strengths of association by subgroups in job strain-cardiovascular disease analyses with respect to social class, gender, and working hours; and (c) review of results of monitoring job strain-blood pressure associations and associated methodological issues.

Psychophysiologic sensitization to headlight glare among professional drivers with and without cardiovascular disease

Previous studies have shown that young, healthy professional drivers show heightened central nervous system arousal and cardiovascular hyperreactivity to simulated headlight glare. Electroencephalographic and cardiovascular response and recovery to simulated headlight glare (the glare pressor test) were examined in 4 groups of male professional drivers (age 25-52 years)--12 with ischemic heart disease (IHD), 12 with hypertension (HTN), 10 with borderline hypertension (BHTN), and 34 who were healthy--and in 23 non-professional driver controls--with the aim of assessing sensitization to this night driving stressor in relation to degree of cardiovascular disease severity. After glare exposure the IHD drivers showed the most pronounced alpha blockade, a rise in diastolic blood pressure (DBP; p < .05), and, unlike the other groups, a persistent fall in finger pulse volume (p < .02). The BHTN group reacted initially with DBP rise and finger pulse drop (ps < .05 and .02, respectively), mainly without central nervous system arousal. The DBP remained constant in normotensive professional drivers older than 40. The drivers' cardiovascular responses to glare were inversely related to reported stressors and subjective experience. Anxiety trait and long work hours were associated with heightened central arousal to glare in professional drivers. The results suggest that there may be progressive degrees of sensitization to glare exposure in these samples, with the least among normotensive professional drivers older than 40, moderate levels in borderline hypertensives, and the most severe in drivers with IHD.

Decision latitude, job strain, and myocardial infarction: a study of working men in Stockholm. The SHEEP Study Group. Stockholm Heart epidemiology Program

OBJECTIVES

This study examined the role of decision latitude and job strain in the etiology of a first myocardial infarction.

METHODS

Eligible case patients were all full-time working men 45 to 64 years of age who suffered a first myocardial infarction during the period January 1992 to January 1993 in the greater Stockholm region. Referents were selected from the general population. Participation rates were 82% (case patients) and 75% (referents).

RESULTS

Both inferred and self-reported low decision latitude were associated with increased risk of a first myocardial infarction, although this association was weakened after adjustment for social class. A decrease in inferred decision latitude during the 10 years preceding the myocardial infarction was associated with increased risk after all adjustments, including chest pain and social class. The combination of high self-reported demands and low self-reported decision latitude was an independent predictor of risk after all adjustments.

CONCLUSIONS

Both negative change in inferred decision latitude and self-reported job strain are important risk indicators in men less than 55 years of age and in blue-collar workers.

Fathers' experience of childbirth and its relation to crying in his infant

As part of a research project exploring ways through which we can understand the crying infant and its family, this study focuses on the experiences of fathers during labour and delivery of their infant. In a previous part of the project it was shown that fathers' negative experiences during the childbirth were correlated with the amount of crying in the infant during the first months after birth. The aim of the present study was to explore and interpret the experiences that fathers reported in an interview when the infant was between six months and one year of age. A hundred and nine fathers were interviewed. The interviews, which took place in the families' homes and with both parents present, were carried out in dialogue form with open-ended questions. The results reveal that complications during the delivery were significantly correlated with the amount of crying in the infant. Feelings of helplessness, of guilt and that staff behaviour had been negative were more common in the group of fathers who experienced the delivery as a negative event. 'Locus of control' seems to be the most relevant concept.

Fighting for and losing or gaining control in life

In JP Henry's work, fighting for and losing control were important concepts in the interpretation of energy mobilization in psychosocial conditions. Attachment and support were important protective and salutogenic factors. These concepts have been applied in a series of epidemiological and psychophysiological real life studies. Job conditions which force the worker to mobilize energy and concomitantly inhibit anabolism could be identified at least partly by means of the demand-control-support model originally proposed by Karasek. The most adverse conditions at work arise when psychological demands are high and at the same time the decision latitude is low. This combination is associated with changes in the regulation of endocrine parameters as well as with increased morbidity--heart disease, functional gastrointestinal symptoms and musculoskeletal disorders. Examples of studies of physiological correlates of psychosocial processes leading to fight for control are also described from outside work activities.

Combined somatic and psychiatric care--effects on personnel treating drug addicts with infectious diseases

Infectious disease care, psychiatric care of drug addicts, and social care were combined in a ward for drug addicts with infectious diseases. The aim of this study was to evaluate the effects on the personnel (n = 22). One ward with infectious disease care of HIV and AIDS patients (n = 24) and another with nonsomatic care of drug addicts (n = 18) were selected to make comparisons possible. The questionnaire concerned psychosocial work environment and health. The personnel at the new ward also participated in a semistructured interview. The personnel at the special ward experienced a significantly higher degree of emotional exhaustion and lack of ability to concentrate than the comparison groups. They also reported a higher degree of lack of clarity, more job strain, and more difficulties due to demands from patients. The combined care is probably associated with heavier psychological burdens than other forms of care. In spite of this, the personnel experienced their work as meaningful and mentally stimulating.

Cardiovascular dysfunction related to threat, avoidance, and vigilant work: application of event-related potential and critique

An integrative approach is suggested to track symbolically simulated work environment stressors, as an act to burden higher cortical function in the exposed groups. ERP would be made together with measurement of end organ stress responses as well as measurements of perceived conditions. Field studies would be the necessary complement. The following conclusions are culled from the reviewed literature: among the pilots, cardiovascular problems are the most important cause of loss of licence in Europe and North America. Interactions with coworkers for air traffic controllers have been associated with cardiovascular disability. Comparing various degrees of heart disease severity among professional drivers, the IHD drivers showed the smallest N2 amplitudes and the greatest diastolic blood pressure reactivity. P300 target amplitude showed an inverse correlation with number of work hours behind the wheel. The IHD drivers were envisioned in a phase of disturbance of the selective attentional process. An interrelation has been found between Event-Related Slow Potential ERSP and midinterval heart rate acceleration associated with displeasure and arousal. A positive correlation has been found between the amplitude of the ERSP and ventricular arrhythmia rate in cardiac patients. Lowering of arrhythmia rate in response to antiarrhythmic agents was associated with a significant attenuation of the ERSP. Either acceleration or deceleration is associated with the appearance of the late CNV to the aversive noise burst. There might be a "common generator behind both anticipatory heart rate responses and cortical events." CNV might be related to frontally mediated stress mechanisms.

Working conditions and family situation in relation to functional gastrointestinal disorders. The Swedish Dyspepsia Project

OBJECTIVE

To examine whether improvement and/or deterioration of functional gastrointestinal symptoms relate to psychosocial factors, and whether patients with such symptoms have special characteristics with regard to working environment in comparison to a referent population.

DESIGN

Multicentre, prospective study of consecutive patients seeking medical advice at health centres for gastrointestinal symptoms.

SETTING

Several municipalities in Sweden: Vänersborg, Trollhättan, Tibro, Alfta, Borensberg, Malmö, Kungälv, Hudiksvall, Vadstena, and Sandviken.

PARTICIPANTS

615 patients, aged 18-81 years, who after medical examination, upper endoscopy and laboratory test were defined as having functional gastrointestinal disorders.

MAIN OUTCOME MEASURES

Initial characteristics and response to treatment according to a 5-graded symptom score as obtained from a psychosocial questionnaire collected during and at the end of a four-week treatment period.

RESULTS

Patients with functional gastrointestinal disorders differed from a referent population of actively employed women and men in the county of Stockholm. They felt less possibility to influence their working conditions. Shift workers were also overrepresented. Psychosocial background factors had an effect on improvement of symptoms during four weeks of treatment. There were some differences between men and women. For women, working hours and home circumstances were important. After four weeks women who worked part-time felt better than those who worked full-time. Married women made a better recovery than single women. For men, working conditions had a greater effect on recovery. Those who felt that they received support from their colleagues at work improved to a greater extent than the other men.

Associations between self-rated psychosocial work conditions and musculoskeletal symptoms and signs. Stockholm MUSIC I Study Group

OBJECTIVES

The aim was to study the associations between self-rated psychosocial work conditions and the characteristics and location of musculoskeletal symptoms, signs, and syndromes.

METHODS

Perceived psychosocial work conditions were recorded in a cross-sectional study with 358 men and women in various occupations. Symptoms were recorded from the musculoskeletal system with a questionnaire, and signs were detected in a medical examination of all body regions. The analyses of statistical associations between the psychosocial factors and musculoskeletal disorders were performed with control for age, gender, and physical load.

RESULTS

The most consistent and pronounced associations were mainly seen between poor psychosocial work conditions and coexisting symptoms and signs of the neck and back regions. Poor psychosocial work conditions were more consistently and strongly associated with signs of muscular (soft tissue) tenderness than with signs of tenderness in the joints, tendons, or muscular insertions or signs in nerve compression tests. Mainly low social support at work, but also high psychological demands and high job strain, were associated with such symptoms and signs, whereas decision latitude at work showed few associations with musculoskeletal disorders.

CONCLUSIONS

Perceived poor psychosocial work conditions are statistically associated mainly with symptoms and signs of muscular tenderness in the central body regions. Studies on associations between psychosocial work conditions and musculoskeletal disorders should separate effect measures of different clinical signs and different body regions in order to avoid attenuation of the risk estimates.

Coping style and social support in women suffering from cluster headache or migraine

BACKGROUND

Many clinical neurologists have considered cluster headache patients to differ from migraine patients as to behavioral patterns. There is, however, little empirical validation of such a differentiation.

METHODS

Coping profiles and social networks were studied in patients suffering from two kinds of recurrent headache. Twenty-four female patients with cluster headache, aged 23-72 years, and 24 age-matched migraine patients with and without aura participated in the study. All female cluster patients treated at the neurologic clinic of the hospital were included, and consecutive outpatients, who had been referred to the policlinics for diagnosis and treatment, whose symptoms agreed with the IHS criteria for migraine and who had ages matching the cluster headache patients, participated in the study.

RESULTS

In the semiprojective coping tests the cluster headache patients were found to be statistically significant more 'positive' as to their anticipated activities in the future compared to the migraine patients (p < 0.04). No other statistical differences were found between the two groups. Compared to randomly selected and age-matched referents in the population. cluster headache patients reported significantly poorer social support (p < 0.01), while no other difference was found when the migraine patients were compared with controls.

CONCLUSIONS

The findings indicate that there are differences in perception of anticipated activities and social support between patients with cluster headache and migraine.